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Scientists Study Why the
Elderly Fall
By
LAURAN NEERGAARD,
Los Angeles Times
January 20, 2003
WASHINGTON -- The elderly man stepped onto an elevated track and began
walking, sensors measuring his gait, muscle use and the force of each
step. Suddenly he slipped -- and cameras filmed his limbs flailing as he
fought to stay upright.
In the name of science, soapy water was spilled on the track to make it
slippery. But don't worry; Virginia Tech researchers had strapped the man
into a safety harness so he never hit the floor.
Millions of elderly Americans aren't so lucky, taking tumbles that can
cause broken hips and other serious injuries, and about 10,000 seniors a
year actually die from falls.
There are precautions that people can take, from getting rid of throw rugs
and updating glasses prescriptions to wearing hip-protecting pads. But
experiments like Tech's aim to pinpoint the aging-caused physiologic
changes that make one senior more prone to a bad fall than another -- and
find new, better protections.
One early finding: The young seem almost as likely to slip on a slick
track as healthy elderly people, says Thurmon Lockhart, chief of Tech's
locomotion research lab. But aging degrades the ability to recover and
keep a slip from turning into a full fall.
One in three people aged 65 and older falls each year. The government
counts 2.2 million who need medical attention, and one in 10 falls causes
a serious injury. Among the worst are the 340,000 annual broken hips,
because they too often trigger a downward spiral. A quarter of those
patients die within a year; 40 percent need a nursing home; and half who
make it to rehabilitation still never walk unaided again.
Medical guidelines call for health workers to evaluate everyone 75 or
older for their risk of falling, using easy gait and balance tests, and
then to customize precautions they can take.
But too few doctors follow those guidelines, says Dr. Mary Tinetti of Yale
University, who recently reviewed proven fall preventions in The New
England Journal of Medicine.
"Falls just don't have the same ... amount of publicity, attention,
respect," as other health threats, she says.
In addition to age, risk factors include: a dip in blood pressure when
suddenly standing up; arthritis; impaired vision, balance or muscle
strength; dementia; and using four or more prescription medicines,
especially certain antidepressants and epilepsy or heart medications that
skew balance.
Add somebody who has bone-thinning osteoporosis, and a fall is guaranteed
to be worse.
"Any internal medicine doctor sees 10 of these people every day and
doesn't recognize" the warning signs, Tinetti says.
Denial and embarrassment keep patients from seeking help, too, adds Dr.
Todd Schlifstein of New York University Medical Center. He cites a
90-year-old who always came to his office tottering on high heels, and
other patients who wouldn't admit to falling until their children tattled.
"The question is how many do things they shouldn't be, who need help
at home," he says.
But the specific physical changes that determine why one senior who slips
will fall while another won't are poorly understood, says Virginia Tech's
Lockhart. For example, as we age and walk slower our heels hit the floor
harder, increasing slips. He wants to know why, understanding that might
lead to more skid-proof floor surfaces or shoe soles.
In the Virginia Tech study, so far 28 younger people and 38 healthy
elderly participants -- including an 80-something marathon runner -- have
harnessed up to be measured while they walk and slip. Lockhart also is
testing 10 frail elderly people, too fragile to trip up but their regular
walking style will prove a good comparison.
It's research that will take years.
But there are some simple changes already scientifically proven to help,
Tinetti says:
* Special exercises to improve balance and strength.
* Tapering off fall-inducing medications, if the patient is stable or has
alternatives.
* Having an occupational therapist assess and fix hazards unique to each
home, such as removing slip-inducing rugs, adding stair rails, telling the
frail to get help carrying laundry down steep staircases.
* For people with thin bones, wearing a hip protector, a plastic or padded
cushion that acts as something of a shock absorber for that vulnerable
joint.
The British Medical Journal recently reported that in German nursing
homes, hip protectors decreased broken hips by 40 percent. They're not
popular, mostly because they do add some bulk under clothing. But they are
widely marketed, although there's no data to say which style works best,
Tinetti says.
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